Provider Demographics
NPI:1962558379
Name:PORTER, JAMES MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MICHAEL
Last Name:PORTER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2309 POWHATTAN ST
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-5325
Mailing Address - Country:US
Mailing Address - Phone:618-465-2183
Mailing Address - Fax:618-465-1288
Practice Address - Street 1:2309 POWHATTAN ST
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-5325
Practice Address - Country:US
Practice Address - Phone:618-465-2183
Practice Address - Fax:618-465-1288
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL261089OtherHEALTHLINK
IL5021556OtherATENA US HEALTH CARE
IL352770Medicare ID - Type UnspecifiedMEDICARE
IL261089OtherHEALTHLINK